Hospital audits reveal more Medicare overpayments

New York Downtown Hospital received $423,978 in Medicare overpayments because it did not have adequate controls to prevent incorrect billings and staff didn't fully understand Medicare billing requirements, the Office of Inspector General (OIG) said in yesterday's audit report.

The hospital complied with Medicare billing requirements for 128 of the 186 claims OIG reviewed from July 2008 through December 2010, but it missed the mark on the remaining 58 claims. Twenty two incorrect inpatient claims resulted in $423,978 in overpayments, while 36 incorrect outpatient claims had no overpayments, the agency said.

Since the audit, New York Downtown Hospital has a physician conduct medical necessity reviews of all short stays admissions and adjusted its edit to accurately identify and hold admissions within 30 days of discharge.

Similarly, thanks to poor billing controls, the University of Colorado Hospital had errors for 28 of 164 claims reviewed, resulting in nearly $310,000 in overpayments in 2008 and 2009, the OIG said in a report also released yesterday. The hospital received $165,760 in overpayments for 21 erroneous inpatient claims and $143,167 for seven outpatient claims.

However, the hospital disputed that the overpayments stemmed from inadequate billing controls. Most of the errors, University of Colorado Hospital noted, were nonsyemtemic and caused by human nature, adding that additional internal controls cannot catch all human errors.

Meanwhile, after OIG audits revealed overpayments and billing requirement misunderstandings at Bay Medical Center in Panama City, Fla., and Kent County Hospital in Warwick, R.I., the hospitals retrained staff on Medicare compliance.

To learn more:
- here's the OIG summary and report (.pdf) for New York Downtown Hospital
- check out the OIG summary and report (.pdf) for University of Colorado Hospital